A care home manager discusses how the pressures facing the sector – including budget cuts and high staff turnover – impact on some of the most vulnerable people in society
I am the manager of a care home for adults with learning disabilities, autism and challenging behaviour. These are people who are mostly unable to express themselves verbally, can’t live without support and can become aggressive after breakdowns in communication. Sometimes this results in them banging their heads against walls or throwing things, which can be very distressing both for the staff and for the residents – although it doesn’t happen as frequently as in other services I have worked in.
I oversee a team of about a dozen staff, whose role is to keep our residents safe while trying to help them be as independent as possible. But they do need a lot of support in every area: having baths, cleaning their teeth, doing their laundry and preparing meals. We also help them access the community and keep on top of their health and finances.
These are some of the most vulnerable people in society, so the service that homes like ours provide will always need to exist. But it’s a question of quality. The citizens we care for deserve those services to be good; they deserve choice about how they’re cared for, how they develop independence, and how they do the things they want to do. That doesn’t come cheap.
The biggest part of the local authority budget is adult social care, and the biggest part of the adult social care budget is learning disabilities. So in a climate of austerity, there’s a huge amount of money to be saved in those services.
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With local authorities having to be more mindful than ever of the bottom line, I fear councils will start looking more at what service users strictly need – as opposed to what is necessarily good for them, or fun, or fulfilling. Whether certain savings can work depends on each individual case; sometimes a lot of money can be saved in a way that doesn’t negatively affect the residents’ environment.
A residential service with five people is far more cost cost-efficient than having two, for example. It might seem like a bad thing to put people in larger groups, but as long as it actually works for those residents, and as long as our Care Quality Commission inspectors agree, I think it’s OK.
Having said that, we haven’t had a CQC inspection in the 18 months I’ve been manager here, so we are probably due one. They are never a particularly pleasant experience – no no-one likes having their work scrutinised so closely – but they are necessary. It’s inevitable they will find things we need to improve because there is no perfect service, but what’s important is we use that as a tool to provide better care.
The biggest issue affecting the quality of care is probably consistency in staffing. After merging with another service we were left with 12 full-time roles, plus a couple of night workers, for five residents. We can make savings by covering shifts ourselves when people go off sick or on holiday. But there’s a limit to those kinds of savings. Can we run the service on even fewer staff? I suppose the blunt answer is not without a loss of quality. Our residents need one-to-one support in the community – and more or less one-to-one staffing for most activities at home – so you become limited as to what they can do day-to-day if you cut staffing back any further.
I’ve been in care for about 11 or 12 years now, nine or 10 of which have been in this range of services. This is my first management role. Most of my staff have been in the service for many years, and I think a lot of that is down to working for the local authority, which includes good pay, benefits and support. I have worked in the private sector before and there is a much higher turnover of staff, which doesn’t work for the service. If staff are inexperienced, badly trained or don’t know the residents very well, the service lacks and that can manifest itself in more challenging behaviour, which is harder for staff and can result in them leaving. In other words, it can create a bit of a vicious circle.
Looking ahead to the possibility of more budget cuts, we end up with a conflict of interest if we are expected to save on staffing. This is because – as the Care Act rightly says – we must make sure people have a say on the kind of care they want and need, and we must keep away from the institutional model of 20-30 years ago. But if more cuts are looming, there is a real danger we could fall back into that outdated way of working. There’s no denying the institutional set-up is a cheaper way to look after people, but if we want to fulfil our obligations to our residents, and give them a decent quality of life, we must have the adequate resources to do so.